So i have a scheduled admission today. I was a few minutes early. Met family member, who lives out of state-he is poa and he is well organized. He provides a copy of his power of attorney, a list of medications, a list of daily duties he expects the nurse, hospice aide, and volunteer to provide DAILY, and a 6 page set of instructions of physical therapy exercises he expects nurse to complete every day with patient..............................family member reiterates and requests writer to agree to implementing each page duties to be incorporated into patients care plan.
I educate that we expect our patients to decline, that hospice is for patients that have a 6 month or less life expectancy, should the disease process take a normal course. He stated "i expect her to make a full recovery." Writer educates that if a patient is improving, that legally we have to run the course to discharge the patient. He states "i've heard of patients being on hospice for years..." Yes, back in the day, you could have a patient take a decline, then improve, decline and improve-but with changing healthcare regulations-the company may be fined 3 times what we received in payment should we keep a patient on service that is not declining, or is not going to pass in 6 months.
wait for it.....it gets better.......
Patient with stage IV lung cancer, family member states she currently walks with a walker, but "i expect her to make a full recovery...." Writer attempts to educate what hospice is.....comfort measures until nature takes its course. ((i'm a weekend on call nurse-my job is to put out fires, control patient symptoms, and generally help to keep the patient out of the emergency room)).....Family member tell me that he expects "daily nursing visits," writer educates-when a patient is receiving daily nursing visits-they are experiencing uncontrollable symptoms or a rapid decline (pt pps is still 50%), Family member then states that he expects a home health aide or volunteer for 6-7 hours a day as this is what he was "promised" by marketing..."
This is where we hit an impasse.....
I called my clinical manager (who just happened to have spent an hour with this family member yesterday, attempting to educate about what hospice IS and what it ISN't..........clinical manager said yesterday, on his list was "daily watering of plants"..........My clinical manager spoke with him on the phone and reiterated that hospice does not provide a sitter for 6-7 hours a day.......Family member reiterated"my mother is expected to be alone every day!" ((family member has a sister that resides with patient and we don't replace the family.....family members response is "yes, but she leaves to go shopping and such....)).
SO, family member was pleasant about it but said to me "i don't have time for your apologies....I have to call home health so they can visit today." He walked me to the door......
Sometimes i just feel like I am spinning my wheels.....This family member is needing senior sitters or similar. No healthcare plan is going to cover sitters.........we do range of motion, but we don't do 6 pages of physical therapy exercises with a patient. At the greatest, a nursing visit may take 45minutes to an hour.
Thank you for listening. I was so frustrated, I took another blood pressure pill. My face is still red and I can feel the heat coming off of it...I know that marketing has to "sell" a service, but I can't provide what this man is wanting for his mother--hospice works in partnership with the family-not as a replacement for the family...
I guess it's a good thing the "marketers" at my company are all RNs and the intake coordinators are LPNs. I just recently started but it seems okay so far. We will see.
When I get demanding families like that I explain that we are a support service, not a caregiving service. We support the families and teach them how to care for their loved one, but we do not take over. I had one marketer tell the family we were just like the hospital, just at home and the phone was her call bell. She had called to clean pt up. He was already on my list for weekend visit, so I went out and explained it in person.
As an on call nurse for many years, I have also had some case managers tell the families I would come out whenever they wanted for anything, doesn't happen too often, and usually from a new case manager.
i have been seeing more evals for non qualified pt's because the Dr. Wants to get rid of them or they have gone to the hospital too much (seeing more and more of this one) they don't want to have re admits so they send them to us. Unfortunately, our company seems to think because a referral came in, they must be admitted. They will go behind my back after I have done eval and said they do not meet criteria, and they admit them anyway. They must pressure doc because she reverses the no, and finds a dx to admit with.
I think I would like to be an inspecter for Medicare, because it has been in every hospice I have worked in. I always wondered if they even care as long as they do not go to hospital because it is still cheaper for them. However, many people double dip and I have also heard a marketer tell a family that they can just revoke, go to hospital and then come back on service.
Purple_roses
1,763 Posts
That poor patient with stage IV lung cancer! That relative is going to run the poor patient ragged!